Provider Demographics
NPI:1366761686
Name:WESTERN MONTANA CLINIC PC
Entity type:Organization
Organization Name:WESTERN MONTANA CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR ANCILLARY & SATELLITE SERV
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-721-5600
Mailing Address - Street 1:PO BOX 7609
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59807-7609
Mailing Address - Country:US
Mailing Address - Phone:406-721-5600
Mailing Address - Fax:
Practice Address - Street 1:11350 US HIGHWAY 93 S
Practice Address - Street 2:LOLO FAMILY PRACTICE
Practice Address - City:LOLO
Practice Address - State:MT
Practice Address - Zip Code:59847-9689
Practice Address - Country:US
Practice Address - Phone:406-273-0045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty